-
Acta Neurochirurgica Nov 2020The semi-sitting position in neurosurgical procedures is still under debate due to possible complications such as venous air embolism (VAE) or postoperative...
BACKGROUND
The semi-sitting position in neurosurgical procedures is still under debate due to possible complications such as venous air embolism (VAE) or postoperative pneumocephalus (PP). Studies reporting a high frequency of the latter raise the question about the clinical relevance (i.e., the incidence of tension pneumocephalus) and the efficacy of a treatment by an air replacement procedure.
METHODS
This retrospective study enrolled 540 patients harboring vestibular schwannomas who underwent posterior fossa surgery in a supine (n = 111) or semi-sitting (n = 429) position. The extent of the PP was evaluated by voxel-based volumetry (VBV) and related to clinical predictive factors (i.e., age, gender, position, duration of surgery, and tumor size).
RESULTS
PP with a mean volume of 32 ± 33 ml (range: 0-179.1 ml) was detected in 517/540 (96%) patients. The semi-sitting position was associated with a significantly higher PP volume than the supine position (40.3 ± 33.0 ml [0-179.1] and 0.8 ± 1.4 [0-10.2], p < 0.001). Tension pneumocephalus was observed in only 14/429 (3.3%) of the semi-sitting cases, while no tension pneumocephalus occurred in the supine position. Positive predictors for PP were higher age, male gender, and longer surgery duration, while large (T4) tumor size was established as a negative predictor. Air exchange via a twist-drill was only necessary in 14 cases with an intracranial air volume > 60 ml. Air replacement procedures did not add any complications or prolong the ICU stay.
CONCLUSION
Although pneumocephalus is frequently observed following posterior fossa surgery in semi-sitting position, relevant clinical symptoms (i.e., a tension pneumocephalus) occur in only very few cases. These cases are well-treated by an air evacuation procedure. This study indicates that the risk of postoperative pneumocephalus is not a contraindication for semi-sitting positioning.
Topics: Adult; Female; Humans; Male; Middle Aged; Neuroma, Acoustic; Neurosurgical Procedures; Patient Positioning; Pneumocephalus; Postoperative Complications; Postoperative Period; Retrospective Studies; Risk Factors; Sitting Position
PubMed: 32712719
DOI: 10.1007/s00701-020-04504-5 -
International Journal of Surgery Case... Sep 2021We report a case of pneumocephalus, which is identified as the presence of air in the cranial cavity and is a rare complication after spinal surgeries, in addition to a...
INTRODUCTION
We report a case of pneumocephalus, which is identified as the presence of air in the cranial cavity and is a rare complication after spinal surgeries, in addition to a literature review of similarly reported cases.
CASE PRESENTATION
The patient is a 63-year-old male who developed pneumocephalus after undergoing a minimally invasive left side decompression at L3-L4 with left L4 foraminotomy even though there were no signs of dural tears or Cerebrospinal Fluid (CSF) leaks. After the diagnosis of pneumocephalus using brain Magnetic Resonance Imaging (MRI), the patient was treated conservatively and was discharged after 3 weeks without developing further complications.
DISCUSSION
Pneumocephalus is defined as an abnormal accumulation of air within the cranial cavity. It can occur due to a variety of causes but rarely due to gas forming bacteria. Many theories are suggested concerning the pathophysiology of pneumocephalus, the inverted bottle theory, the ball valve theory, the Nitrous Oxide (NO) theory, and as we outweigh in our case, gas forming bacteria theory. Pneumocephalus can be treated surgically, nevertheless, conservative management methods of such cases are usually followed.
CONCLUSION
The aim of this study is to draw further attention to the management and diagnosis of such surgical complication. A more extended research is needed to provide a full comprehensive approach to deal with this problem if faced in the future. To the best of our knowledge, this study reports the first pneumocephalus case induced by a postoperative bacterial infection in the global English based medical literature.
PubMed: 34479115
DOI: 10.1016/j.ijscr.2021.106342 -
Cureus Jul 2020The combination of catatonia and pneumocephalus is very rare and literature is very scarce on this topic. Here, we report a patient with pneumocephalus and catatonia...
The combination of catatonia and pneumocephalus is very rare and literature is very scarce on this topic. Here, we report a patient with pneumocephalus and catatonia after persistent drain dysfunctions and infections after a hydrocephalus due to an aquaduct stenosis. The combination of a catatonic syndrome and pneumocephalus in neurosurgical and intensive care practice is a rare phenomenon. One should consider it in patients after complicated neurosurgery with pneumocephalus.
PubMed: 32864264
DOI: 10.7759/cureus.9440 -
International Journal of Emergency... May 2009
PubMed: 20157459
DOI: 10.1007/s12245-009-0108-9 -
Journal of Medical Case Reports Oct 2019Pneumocephalus and pneumorachis, presence of air inside the skull and spinal canal, are mostly seen after neurosurgical procedures and neuraxial anesthesia. They have...
BACKGROUND
Pneumocephalus and pneumorachis, presence of air inside the skull and spinal canal, are mostly seen after neurosurgical procedures and neuraxial anesthesia. They have also been described after penetrating trauma, but never after blunt trauma without adjacent bone fractures.
CASE DESCRIPTION
We present the case of an 85-year-old white male patient admitted to our intensive care unit after a high velocity car accident. On site clinical evaluation showed normal consciousness with 15/15 Glasgow Coma Scale after a short initial loss of consciousness. The patient was first sent to a nearby hospital where a whole-body computed tomography scan revealed pneumocephalus and pneumorachis and an important left hemopneumothorax with pneumomediastinum with extensive subcutaneous emphysema. The state of the patient quickly worsened with hemorrhagic shock. The patient was sent to our intensive care unit; upon neurosurgical evaluation, no surgical indication was retained due to the absence of skull and spine fracture. A computed tomography scan performed on day 6 showed total regression of the pneumocephalus and pneumorachis. A follow-up computed tomography scan performed on day 30 revealed no intracranial bleeding or stroke, but a left pleural hernia between ribs 5 and 6. Due to respiratory complications, our patient could not be weaned from ventilator support for a proper neurological examination. Our patient's state finally worsened with septic shock due to ventilator-acquired pneumonia leading to multiple organ failure and our patient died on day 37.
CONCLUSIONS
This is the first case report to describe pneumorachis and pneumocephalus following blunt trauma with pneumothorax, but no spinal or skull fractures. The mechanism that is probably involved here is a migration of air with subcutaneous emphysema and a pleural hernia into the spinal canal. However, in cases of pneumorachis or pneumocephalus, skull fractures need to be investigated as these require surgery and appropriate vaccination to prevent meningitis.
Topics: Accidents, Traffic; Aged, 80 and over; Fatal Outcome; Hemopneumothorax; Humans; Male; Mediastinal Emphysema; Multiple Organ Failure; Pneumocephalus; Pneumonia, Ventilator-Associated; Pneumorrhachis; Shock, Hemorrhagic; Subcutaneous Emphysema; Thoracic Injuries; Tomography, X-Ray Computed; Whole Body Imaging; Wounds, Nonpenetrating
PubMed: 31651338
DOI: 10.1186/s13256-019-2208-3 -
Cureus Jan 2021Pneumocephalus is defined as the presence of air inside the cranial vault. Benign and tension pneumocephalus are different ends of the same disease spectrum. Tension...
Pneumocephalus is defined as the presence of air inside the cranial vault. Benign and tension pneumocephalus are different ends of the same disease spectrum. Tension pneumocephalus leads to the formation of a pressure gradient, requiring emergent surgical decompression to prevent herniation of the intracranial structures. In this report, we present a rare case of tension pneumocephalus with essentially benign radiological findings secondary to a ruptured cholesteatoma. The patient was a 64-year-old woman with a history of end-stage renal disease on hemodialysis and hypertension. She presented to the emergency department (ED) with acute-onset weakness and decreased mentation. Physical exam findings were consistent with a cerebrovascular accident (CVA). CT scan and CT angiogram (CTA) were unremarkable for ischemia or hemorrhage but showed signs of free intracranial air, consistent with the diagnosis of pneumocephalus. After the activation of the code stroke, neurosurgery and neurology were consulted. Worsening respiratory status led to a decision to proceed with emergent intubation, but it was held based on the family's decision to proceed with comfort measures. The patient's status declined further within minutes and she died. Afterward, the case was discussed with the radiologist, who interpreted the cause as a cholesteatoma that had eroded through the temporal bone.
PubMed: 33633902
DOI: 10.7759/cureus.12873 -
Scientific Reports Aug 2020This study investigates the effects of aircraft cabin pressure on intracranial pressure (ICP) elevation of a pneumocephalus patient. We propose an experimental setup...
This study investigates the effects of aircraft cabin pressure on intracranial pressure (ICP) elevation of a pneumocephalus patient. We propose an experimental setup that simulates the intracranial hydrodynamics of a pneumocephalus patient during flight. It consists of an acrylic box (skull), air-filled balloon [intracranial air (ICA)], water-filled balloon (cerebrospinal fluid and blood) and agarose gel (brain). The cabin was replicated using a custom-made pressure chamber. The setup can measure the rise in ICP during depressurization to levels similar to that inside the cabin at cruising altitude. ΔICP, i.e. the difference between mean cruising ICP and initial ICP, was found to increase with ICA volume and ROC. However, ΔICP was independent of the initial ICP. The largest ΔICP was 5 mmHg; obtained when ICA volume and ROC were 20 ml and 1,600 ft/min, respectively. The postulated ICA expansion and the subsequent increase in ICP in pneumocephalus patients during flight were successfully quantified in a laboratory setting. Based on the quantitative and qualitative analyses of the results, an ICA volume of 20 ml and initial ICP of 15 mmHg were recommended as conservative thresholds that are required for safe air travel among pneumocephalus patients. This study provides laboratory data that may be used by doctors to advise post-neurosurgical patients if they can safely fly.
Topics: Aerospace Medicine; Air Pressure; Air Travel; Aircraft; Altitude; Brain; Environment, Controlled; Humans; Intracranial Hypertension; Intracranial Pressure; Male; Middle Aged; Models, Theoretical; Pneumocephalus; Skull
PubMed: 32788610
DOI: 10.1038/s41598-020-70614-w -
Journal of Neurology, Neurosurgery, and... Mar 1974A 60 year old male had an open thoracotomy for bronchogenic carcinoma. On the twelfth hospital day he became obtunded and complained of headache. Radiographs revealed...
A 60 year old male had an open thoracotomy for bronchogenic carcinoma. On the twelfth hospital day he became obtunded and complained of headache. Radiographs revealed intracranial air. It was thought that the pneumocephalus in this patient was most likely secondary to a tension pneumothorax continuously forcing air through a dural tear sustained at the time of initial surgery. The causes of pneumocephalus are reviewed and no similar case report has been found in the literature.
Topics: Carcinoma, Bronchogenic; Dura Mater; Humans; Lung Neoplasms; Male; Middle Aged; Pneumocephalus; Pneumothorax; Postoperative Complications; Radiography
PubMed: 4829533
DOI: 10.1136/jnnp.37.3.271 -
Cureus Sep 2021Pneumocephalus is defined as the presence of air in the intracranial cavity, and this complication is rare after ventriculoperitoneal shunt (VPS) surgery. It can be...
Pneumocephalus is defined as the presence of air in the intracranial cavity, and this complication is rare after ventriculoperitoneal shunt (VPS) surgery. It can be caused by traumatic brain injury (TBI), surgical interventions, and anatomical or spontaneous malformation. We present a case of intraventricular pneumocephalus associated with the placement of a VPS. The patient was a 40-year-old man who had a VPS inserted 10-years ago due to hydrocephalus caused by TBI. He presented to the emergency room with complaints of headache, vomiting, rhinoliquorrhea, and fever. Computed tomography of the skull showed ventricular dilatation with intraventricular pneumocephalus. In a three-dimensional reconstruction, a bone defect was visualized with meningocele at the base of the skull that would explain the cerebrospinal fluid fistula. The meningocele was surgically corrected. After 14 days of antibiotic treatment, a new VPS was placed and the patient progressed satisfactorily. Pneumocephalus associated with VPS is a rare condition that can develop secondary to a combination of the shunt effect and an anatomical defect at the base of the skull. Excessively negative and persistent intracranial pressure of the shunt allows air to enter and fill the existing vacuum through the defect in the skull base. This bone defect may be congenital, due to traumatic brain injury, or a result of hydrocephalus itself. Computed tomography of the skull is an excellent investigation for the visualization of bone defects, and treatment involves a correction of the fistula. Pneumocephalus associated with VPS is rare. The presence of rhinoliquorrhea is a strong indication of the condition. Once the presence of a fistula is confirmed, it should be corrected to prevent worsening of the pneumocephalus.
PubMed: 34725626
DOI: 10.7759/cureus.18392 -
Agri : Agri (Algoloji) Dernegi'nin... Jul 2017Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid...
Pneumocephalus is defined as air in the cranial cavity. Pneumocephalus can result from inadvertent dural puncture during lumbar epidural anesthesia or epidural steroid injection. Presently described is case of 41-year-old woman who had undergone lumbar disc hernia operation but due to ongoing complaints, was diagnosed as having failed back surgery syndrome. Percutaneous epidural neuroplasty was performed. In the operating room, under sterile conditions and under sedoanalgesia, Racz catheter was inserted in caudal area and guided to epidural area with scope. In accordance with Madrid Declaration, 20 ug/mL concentration and 5 mL volume oxygen-ozone mixture was injected. After waiting 5 minutes, 0.25% bupivacaine + 80 mg triamcinolone + 1500 units hyaluronidase was administered through the catheter. After epidural neuroplasty procedure, when patient was taken to gurney, she complained of severe headache and nausea. Computed tomography scans of head were done immediately, and consistent with pneumocephalus, air was observed in right lateral ventricle frontal horn, interhemispheric fissure, and superior cerebellar cistern. Patient was placed in Trendelenburg position and intravenous fluid was replaced. Analgesics and bed rest were recommended as treatment. Patient was discharged from hospital on the second day. Within a week, headache pain and other complaints had resolved. In this article, the case of a failed back surgery patient who was postoperatively treated with medical ozone and experienced complication of pneumocephalus is discussed in context of literature data.
Topics: Adult; Diagnosis, Differential; Failed Back Surgery Syndrome; Female; Headache; Humans; Ozone; Pneumocephalus; Tomography, X-Ray Computed
PubMed: 29039154
DOI: 10.5505/agri.2016.36024